IV FLUID AD (1).pptx

IV FLUID ADMINSTRATION - STAFF NURSE TRAINING UNDER DGME KGMU LUCKNOW

1. I.V. FLUID ADMINISTRATION MR OMPRAKASH FACULTY OF COLLEGE OF NURSING, KGMU LUCKNOW

2. INTRODUCTION INTRAVENOUS INFUSION THERAPY PURPOSE OF IV THERAPY COMPONENTS OF FLUID THERAPY BODY FLUID REQUIRMENT TYPES OF SOLUTION USED OBJECTIVE

3. REQUIRMENTS STEPS COMPLICATION

4. Intravenous fluid regulation is the control of the amount of fluid you receive intravenously, or through your bloodstream. The fluid is given from a bag connected to an intravenous line. This is a thin tube, often called an IV, that’s inserted into one of your veins. INTRODUCTION

5. Giving fluids intravenously to a patient. Total body fluid (intracellular and extracellular) amounts to about 60% of body weight in the adult, 55% in the older adult, and 80% in the infant. INTRAVENOUS INFUSION THERAPY

6. To provide patient with fluid when adequate fluid intake cannot be achieved through oral route Unconscious patient Post-operative patients Blood transfusion Diarrhoea and vomiting , in severe burns. PURPOSES OF INTRAVENOUS INFUSION

7. Maintenance therapy : replaces normal ongoing losses. Maintenance therapy is usually undertaken when the individual is not expected to eat or drink normally for a longer time (e.g., preoperatively, or on a ventilator). Replacement therapy : corrects any existing water and electrolyte deficits. COMPONENTS OF FLUID THERAPY

8. NEWBORN – 80 TO 100 ml/kg/day 0 to 1 year – 100 to 150 ml/kg/day 1 to 2 year – 100 to 125 ml/kg/day 2 to 10 year – 75 to 100 ml/kg/day 11 to 15 years – 50 to 75 ml/kg/day Adult – 40 to 60 ml/kg/day BODY FLUID REQUIRMENT

9. For infants 3.5 to 10 kg the daily fluid requirement is 100 mL /kg. For children 11-20 kg the daily fluid requirement is 1000 mL + 50 mL /kg for every kg over 10. For children >20 kg the daily fluid requirement is 1500 mL + 20 mL /kg for every kg over 20,  up to a maximum of 2400 mL daily.

10. Osmolality – refers to the number of osmotically active particles per kilogram of water; it is the concentration of a solution. The normal osmolality of plasma is 270 to 300 milliosmoles /liter or kg.

11. Isotonic solutions (308mOsm/l) Hypotonic solutions (154mOsm/l) Hypertonic solutions( >308mOsm/l ) TYPES OF SOLUTIONS

12. The cell has the same concentration on the inside and outside which in normal conditions the cell’s intracellular and extracellular are both isotonic. Examples : 0.9% Saline 5% Dextrose in 0.225% saline (D5W1/4NS) Lactated Ringer’s ISOTONIC FLUID

13. The cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis. This will cause  CELL SWELLING  which can cause the cell to burst or lyses. Examples : 0.45% Saline (1/2 NS) 0.225% Saline (1/4 NS) 0.33% saline (1/3 NS) HYPOTONIC FLUID

14. The cell has an excessive amount of solute extracellularly and osmosis is causing water to rush out of the cell intracellularly to the extracellular area which will cause the  CELL TO SHRINK. Examples : 3% Saline 5% Saline 10% Dextrose in Water (D10W) 5% Dextrose in 0.9% Saline 5% Dextrose in 0.45% saline 5% Dextrose in Lactated Ringer’s HYPERTONIC FLUID

15. REQUIRMENT OF EQUIPMENT

16. Primary IV tubing can be macro-drip or micro-drip tubing. The drop factor of the IV tubing is required to complete the IV drip rate calculation for a gravity infusion. Remember to invert all access ports and back check valve. Safety considerations: 

17. S.NO STEPS ADDITIONAL INFO 1.   Perform hand hygiene. This step prevents the transmission of microorganisms. 2. Check order to verify solution, rate, and frequency. This ensures IV solution is correct and helps prevent medication error. 3. Gather supplies. You will need IV solution, primary IV tubing, time label, change label, alcohol swab, and basin or sink.

18. STEPS ADD INFORMATION 4.  Remove IV solution from outer packaging and gently squeeze. Tear the perforated corner of the outer packaging; check colour , clarity, and expiration date.

19. 5. Remove primary IV tubing from outer packaging.

20. 6. Move the roller clamp about 3 cm below the drip chamber and close the clamp.

21. 7. Remove the protective cover on the IV solution port and keep sterile. Remove the protective cover on the IV tubing spike. Be careful and do not contaminate the spike.

22. 8.  Without contaminating the solution port, carefully insert the IV tubing spike into the port, gently pushing and twisting. 9. Hang bag on IV pole. The IV bag should be approximately one metre above the IV insertion site.

23. 10  Fill the drip chamber one-third to one-half full by gently squeezing the chamber. Remove protective cover on the end of the tubing and keep sterile. Filling the drip chamber prevents air from entering the IV tubing.

24. 11.  With distal end of tubing over a basin or sink, slowly open roller clamp to prime the IV tubing. Invert back check valve and ports as the fluid passes through the tubing. Tap gently to remove air and to fill with fluid. Inverting and tapping the access ports and backcheck valve helps displace and remove air when priming the IV tubing.

25. 12  Once IV tubing is primed, check the entire length of tubing to ensure no air bubbles are present. This step confirms that air is out of the IV tubing. 13. Close roller clamp. Cover end with sterile dead-ender or sterile protective cover. Hang tubing on IV pole to prevent from touching the ground. Keep the distal end sterile prior to connecting IV to patient. 14  Label tubing and IV bag with date, time, and initials. Label IV solution bag as per agency policy. Do not write directly on the IV bag.

26. 15. This reduces the transmission of microorganisms.

27. The following observations are made throughout the procedure: Flow rate, dislodgement of needle etc Signs of circulatory overload Urinary output Fluid level in the bottle Patency of the I.V. tubing and presence of kinks in the tubing. Sometimes the patient may lie on the tube and block the flow of fluid.

28. Intake and output chart for 24 hours. A fluid balance chart shows on one side the amount and the type of fluid administered and on the other side the amount lost by kidneys, stomach etc Fluid and electrolyte balance; regular estimation of the electrolytes of blood is necessary. The needle site for infiltration and thrombophlebitis .

29. 1. Infiltration – Infiltration is seepage of the IV fluid out of the vein and into the surrounding interstitial spaces. Infiltration occurs when an access device has become dislodged or perforates the wall of the vein or when venous backpressure occurs because of a clot or venospasm . COMPLICATION

30. Avoid venipuncture over an area of flexion. Use an armboard or splint as needed if the client is restless or active. Monitor the IV rate for a decrease or a cessation of flow. Evaluate the IV site for infiltration by occluding the vein proximal to the IV site. PREVENTION AND INTERVENTIONS

31. 2. Phlebitis and thrombophlebitis – Phlebitis is an inflammation of the vein that can occur from mechanical or chemical (medication) trauma or from a local infection. Phlebitis can cause the development of a clot ( thrombophlebitis )

32. Use an IV cannula smaller than the vein, and avoid using very small veins when administering irritating solutions. Avoid using the lower extremities (legs and feet) as an access area for the IV. Avoid venipuncture over an area of flexion. PREVENTION AND INTERVENTIONS

33. Change the venipuncture site every 72 to 96 hours in accordance with CDC recommendations and agency policy. If phlebitis occurs, remove the IV device immediately and restart it in the opposite extremity; notify the HCP if phlebitis is suspected, and apply warm, moist compresses, as prescribed.

34. Provisional infusion therapy standards : Intravenous Nursing New Zealand Incorporated Society Nursing. Human Craven R. & Hirnley C.J(2009). Fundamentals of Health and function (6th ed ). Philadelphia J.B Lippincott Potter P. &Perry A.(2005). Fundamentals of Nursing (6th Ed). St Louis C.V Mosbey . Jacob annamma , clinical nursing procedures: the art of nursing practice, 3 rd edition, jaypee publications, page no: 200-225. Nancy sister, principles and practice of nursing , nursing art procedures, 6 th edition, vol (1), N.R.brothers M.Y.H.road , Indore, 2007, page no:115 -131. Web Bliography www.shareshide.com BIBLIOGRAPHY